New survey for lung cancer awareness month

More than one in five people are unable to name any symptoms of the world’s biggest cancer killer, according to a survey published to mark the start of Lung Cancer Awareness Month.

The research, which was carried out by Ipsos MORI on behalf of the Global Lung Cancer Coalition, investigated awareness of the symptoms of lung cancer and smoking prevalence in 21 countries.

Researchers found that across all the countries, 22% of people surveyed admitted they could not name any symptoms of the disease, which claims the lives of 1.37 million people globally every year.

In Britain, the survey found that;

One in five (20%) people were current smokers and those aged 65 or older were more likely to be former smokers than other age groups (39% versus 21% on average). 

When asked to identify the symptoms of lung cancer, breathlessness and a cough were the most commonly stated symptoms (46% and 43%), in line with many other countries surveyed. 

Current smokers were less aware of the symptoms of lung cancer than former smokers and people who had never smoked regularly (22% of smokers, 9% of former smokers and 15% of people who had never smoked don’t know any).

The Global Lung Cancer Coalition’s British members include the British Lung Foundation, the National Lung Cancer Forum for Nurses and the Roy Castle Lung Cancer Foundation.

Dr Penny Woods, Chief Executive of the British Lung Foundation, said: “With lung cancer killing more than any other cancer worldwide, it is concerning that there is still such a lack of lung cancer awareness, especially among smokers. Two out of every five lung cancer diagnoses are made when patients are admitted to A&E but most cases should be detectable long before this stage. It is vital that people become more aware of their lung health and the symptoms of lung cancer—this could make a huge difference in detecting lung cancer at an early stage and increasing the chances of successful treatment. Smoking causes more than 80% of lung cancers so it is also important that we continue to support smokers to quit whilst exploring new ways of discouraging young people from taking it up in the first place such as introducing standardised packaging for all tobacco products”. 

The report found lack of awareness of lung cancer symptoms varied between different countries.

Overall, breathlessness was the most commonly identified symptom (41% of respondents mentioned it spontaneously on average across the countries) but a similar proportion identified a cough or coughing (39% on average across the countries). Others mentioned more specific types of coughing such as coughing blood or a cough that gets worse. 

New lung cancer drug approved

The Scottish health regulator has approved a new drug to treat the country’s biggest cancer killer.

The Scottish Medicines Consortium (SMC) recommended the drug crizotinib should be available for widespread use on the NHS to treat a small group of patients with a type of advanced lung cancer.

The news comes only months after the drug was refused for widespread use on the NHS in England, Wales and Northern Ireland.

Lorraine Dallas, Director of Roy Castle Lung Cancer Foundation in Scotland, said: “This is great news for lung cancer patients in Scotland. Crizotinib represents a very important, new therapy for around 5% of patients with non-small cell lung cancer. However, while this is good news for Scotland, we remain disappointed that it is not similarly available for lung cancer patients in other parts of the UK.”

Crizotinib, which is also known by its brand name Xalkori, is a new type of targeted drug therapy, which works for about one in 20 people (5%) who have non small cell lung cancer.

It blocks an enzyme called anaplastic lymphoma kinase (ALK), which can cause cancer cells to grow. It is not a cure but it can prolong survival and improve quality of life for patients.

Although not approved for widespread NHS use, some patients in England are able to access crizotinib via the Cancer Drugs Fund until 2015. 

The Cancer Drugs Fund is not available in Scotland, Northern Ireland or Wales but the Roy Castle Lung Cancer Foundation advises all lung cancer patients, regardless of where they live, to ask their healthcare providers if ALK testing has been undertaken and if not, to ask the reason why.

New international smoking cessation guidance

The American Society of Clinical Oncology (ASCO) recently outlined a far-reaching strategy to reduce the premature deaths of nearly one billion people worldwide expected this century due to tobacco use. 

ASCO’s policy statement, published in the Journal of Clinical Oncology, focuses on public policy needs, provider education and research on tobacco cessation and control interventions. This is ASCO’s first update to its tobacco control statement since 2003.

This comes at a time when nearly 85% of oncology providers believe tobacco cessation should be a standard part of cancer care, but cite barriers to facilitation including lack of training and patient resistance. These findings are the result of an ASCO member survey on provider attitudes toward tobacco cessation, published in the Journal of Oncology Practice.

“Given the indisputable scientific evidence that tobacco poses a huge burden in cancer incidence and death worldwide, it is our responsibility as cancer doctors to help our patients quit and oppose tobacco use in all its forms,” said Clifford A. Hudis, MD, FACP, President of ASCO. “We are deeply committed to proactive tobacco control and have set an aggressive agenda for moving forward in this critical area.”

 Tobacco use is the leading preventable cause of cancer in the world, contributing to nearly 2.4 million cases of cancer between 1999 and 2004. A growing body of evidence also suggests continued tobacco use after a cancer diagnosis reduces the effectiveness of cancer treatment and increases the likelihood of a second cancer. Smoking and use of other tobacco products may also worsen side effects related to cancer treatment. 

 Overall, tobacco kills more than four million people worldwide—shortening smokers’ lives, on average, by more than seven years. If current trends continue, according to the World Health Organization and the World Bank, the global death toll from tobacco will grow to 10 million annually by 2030.

Top award for discovery of resistance-busting cancer drugs

The discovery of a brand new class of cancer drugs that knock out the defences tumours use to become resistant to treatment has been recognised by the award of one of the UK’s most prestigious cancer research prizes. The award was presented this month at the National Cancer Research Institute (NCRI) Cancer Conference, the UK’s leading annual conference of cancer researchers.

HSP90 inhibitors have sparked excitement in the cancer research world for their ability to attack tumours that have stopped responding to existing drugs—and could be used against a wide range of cancers including lung, breast, prostate, ovarian and colon. Drug resistance is widely recognised as the major challenge in cancer treatment, even with the new targeted therapies, and HSP90 inhibitors have already entered clinical trials worldwide.

Now scientists from The Institute of Cancer Research, London, and The University of Sussex have won the 2013 Cancer Research UK Translational Cancer Research Prize for their pioneering work to understand how HSP90 works, then discover the new drug class and take the first members of it into the clinic. 

The award is given annually for outstanding research that bridges the gap between science in the laboratory and the development of new treatments for patients.

The prize marks the culmination of more than 10 years of work to elucidate the structure and function of a super-protein called Heat Shock Protein 90 (HSP90), which oversees a range of processes that are essential for cancer cells—and to design and evaluate drugs that target HSP90, including one called AUY922 which is now showing promise in patients with drug-resistant cancers. HSP90 inhibitors have shown encouraging results in both breast and lung cancers and the more advanced HSP90 inhibitors are now progressing to phase III trials.

Because HSP90 is critical for many processes that are fundamentally important in cancer, inhibiting it with the new drugs hits cancer hard in several different ways simultaneously, undermining its growth, survival and spread. Targeting HSP90 also knocks out several important molecular mechanisms that are used by cancers as a way of side-stepping the effects of treatment.

The most promising, advanced trials so far include phase II clinical studies in patients with HER2-positive breast cancers which have become resistant to the commonly used antibody drug trastuzumab (Herceptin), and also in patients with non-small cell lung cancer who have become resistant to the widely used drugs erlotinib and crizotinib, which target two tumour pathways driven by cancer genes called ALK and EGFR. HSP90 inhibitors work by causing the destruction of the protein products of these genes, and patients can be selected for treatment using markers for them.

Professor Paul Workman, Deputy Chief Executive of The Institute of Cancer Research and Director of the Cancer Research UK Cancer Therapeutics Unit, initiated and led the HSP90 drug research programme, and is one of the recipients of the new award. He said: “This is a fantastic achievement for our team and terrific recognition for our translation of basic knowledge of HSP90 into drugs like AUY922 that are now showing activity in cancer patients. In the shorter term, HSP90 inhibitors are likely to be used in patients who have become resistant to current treatments, but in the future they could play an even bigger part in tackling cancer as an early-stage treatment and preventing drug resistance arising.”

Diagnosis tool might help distinguish small lung cancer nodules from benign nodules

The National Lung Screening Trial reported a 20% reduction in lung cancer mortality achieved through low dose computed tomography (CT) screening of the at risk population, compared to screening with chest x-ray. Challenges with clinical implementation of CT screening for lung cancer include the high number of lesions detected that require further follow-up, approximately 97% of which are ultimately diagnosed as benign.

A computer-aided diagnosis (CAD) tool can be designed to determine the probability of malignancy of a lung nodule based on objective measurements. While current CAD tools examine the pulmonary nodule’s shape, density, and border, analysing the lung tissue surrounding the nodule is an area that has been minimally explored.

Preliminary findings from researchers from the University of Iowa indicate that CAD can help distinguish between a benign and malignant lesion from the distinguishable features in the nodule and the surrounding tissue.

“CT mediated lung cancer screening in the most at risk patient population has significant potential to save lives, however there is widespread concern regarding the increase in follow up procedures and associated healthcare cost involved with following every identified small nodule, of which less than 5% will be determined to be cancer,” says Dr Jessica Sieren, Assistant Professor of Radiology and Biomedical Engineering at the University of Iowa. 

“The CAD tool we have developed is unique in its designed applicability to small nodules less than 3cm, and preliminary findings show high potential to assist in early nodule diagnoses.”